Algorithm for the Management of Hypoglycaemia in Adults with Diabetes in Hospital

Hypoglycaemia is a serious condition and should be treated as an emergency regardless of level of consciousness
Hypoglycaemia is defined as blood glucose of <4.0mmol/L (if not <4.0mmol/L but symptomatic give a small carbohydrate snack for symptom relief)
See full guideline “The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus” at www.diabetes.org.uk/joint-british-diabetes-society

Mild Moderate Severe

Adults who are conscious, orientated Patient conscious and able to swallow, but Patient unconscious/fitting or very
and able to swallow confused, disorientated or aggressive aggressive or nil by mouth (NBM)

Check ABCDE, stop IV insulin (if running)
Give 15-20g of quick acting carbohydrate,
such as 5-7 Dextrosol® tablets or 4-5 Lift
GlucoTabs® or 150-200ml pure fruit juice**
Test blood glucose level after 10-15 minutes
and if still less than 4.0mmol/L repeat
treatment as above up to 3 times. If still
hypoglycaemic, call doctor and consider IV
dextrose or IM glucagon as per “severe”
pathway
Check ABCDE, stop IV insulin (if running)
If capable and cooperative, treat as for mild
hypoglycaemia. If not capable and cooperative
but can swallow give 2 tubes of 40% glucose gel
(squeezed into mouth between teeth and gums).
Test blood glucose level after 10-15 minutes and
if still less than 4.0mmol/L repeat as above up to
3 times. If still hypoglycaemic, call doctor and
consider IV dextrose or IM glucagon as per
“severe” pathway
Check ABCDE, stop IV insulin, request
medical support urgently.
Give 100ml 20% dextrose or 200ml 10%
dextrose over 15 minutes
If IV access not possible use 1mg
Glucagon IM*
Recheck glucose after 10 minutes and if
still less than 4.0mmol/L, repeat
treatment as above

Check glucose after 10-15 minutes. Once blood glucose level are now > 4.0mmol/L or above: Give If glucose now 4.0mmol/L or above, follow
20g of long acting carbohydrate e.g. two biscuits, slice of bread, 200-300ml milk or next up treatment as described on the left.
carbohydrate containing meal. Give 40g if IM glucagon has been used. For patients with enteral If NBM, once glucose >4.0mmol/L give
feeding tube give 20g quick acting carbohydrate via enteral tube e.g. 50-70ml Ensure® Plus juice or 10% glucose infusion at 100ml/hr until no
Fortijuce®. longer NBM or reviewed by doctor

DO NOT omit subsequent insulin doses. Continue regular capillary blood glucose monitoring *Glucagon may take up to 15 minutes to work and may be
for 24-48 hours. Review insulin and/or oral hypoglycaemic doses. If previously on IV insulin, ineffective in treating hypoglycaemia in undernourished
would generally consider restarting insulin once blood glucose >4.0 but may require review patients, in severe liver disease, sulfonylurea induced
of regimen. Give hypoglycaemia education and refer to inpatient diabetes team. hypoglycaemia and in repeated hypoglycaemia.